Turning No to Yes

To end burnout, physicians need to know things will get better for them and for patients

Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie.

Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to evaluate residents.

And lots of sessions on wellness.

At least we are paying attention to wellness, recognizing that the stress of working in the environment we've allowed to become created around us, in which we try to practice medicine, is detrimental to our well-being.

One of the sessions was titled "Build Your Own Fire Extinguisher -- Practical Ways to Reduce Faculty Burnout."

Most of the sessions occupy those partitioned-off rooms that divide up the larger hotel convention auditorium, usually only used undivided for the plenary sessions or for the special guest speaker.

Each smaller workshop room has 50 seats at most, with handouts on every chair, a little work for us to all to do in the small breakout groups.

But this one was different. The room was packed. Lots of nervous laughter, people standing along the walls, sitting on the floor. Even daring to sit in the front row. Looking for answers.

The presenters looked a little shell-shocked, when they realized how many people had squeezed into the room to hear their solution to provider burnout.

Now, I don't think anyone really thought they were going to give us the answer, the answers, the things we need to do, that one thing we need to change, the couple of things we need to do to make our lives in healthcare as easy as we once imagined they all could be.

But I think there was at least some expectation that we would be given some powerful new tools, some evidence-based techniques to help us all get through the crazy, harried days we are all living in dealing with our current healthcare debacle.

In the end, it was a very well-done workshop. After we reassembled from our workgroups where we all tried to address some barriers and come up with some ideas of our own, they revealed what they'd been doing at their own institution's division meetings.

These folks had collected suggestions from faculty on those things that people thought were contributing to their burnout, and categorizing them as green light, yellow light, or red light.

They went through all the ideas the people submitted, and figured out the way to do the things that were easy to do.

Someone in their division complained about the location of the water cooler, so they moved the water cooler. Someone wanted a UPS pickup box in the office, so that was set up.

These were given the green light, these were the low hanging fruit, these were easy to fix.

Those flagged as yellow lights were things that they might be able to change, they might be able to finagle some money out of the powers-that-be, they might be able to suggest an alternative, but there was no easy automatic fix, no immediate solution, no guarantee that they would get this done.

And the red lights, well, those were the hard No's, the things for which they were just told simply that they could not be done -- that people had tried, that the appropriate authorities had been asked, and a reasonable explanation for why this was never going to happen had been given to them. And everyone should just accept this, and move on. Stop asking.

Red light, stop.

The workshop presenters reported that after they've introduced this concept, this strategy, this new paradigm, to their division, and they now included a response to all of the requests for change in the first few minutes of their quarterly division meeting, that the members of the division reported increased satisfaction by getting some things green-lighted, being told that the yellow lights were works in progress, and getting an explanation why the red lights were never going to happen.

Definitely, there's nothing wrong with a little success, some things that you get green-lighted always make us feel better. And knowing that someone's heard a request, that even though it's not getting approved right now we know they're working on it -- that can make us feel better about those middle-of-the-road ones that are not definitely yes or definitely no.

But it's the red lights we've all been told to accept that make me feel like we've been told too long the answer is no, that change is impossible.

If the answer is no for all the really important things we want to change in our healthcare system, then I think we're asking the wrong people, and I think it's time that the people saying no hear us when we say we're not going to take no for an answer.

We're not talking about silly, frivolous demands. I don't want a gold-plated exam table or a platinum stethoscope.

But when we providers, those of us taking care of patients, say the system is brutally broken and hurting our patients and hurting the members of our healthcare team, then it's time for us to rephrase the questions so we can get the answers we want.

When we recognize that our patients need more mental health resources, we don't want to be told no.

When providers tell us they practice in an environment where they feel unsafe, we don't want to be told no.

When students and residents shun careers in primary care because they experience only its current toxic environment, and we ask for change, we no longer want to be told no.

When we say we cannot live up to the competing demands of crushing volume and the slow attentive pace which our patients need us attending to them to truly get them healthy, we don't want to hear no.

No is the wrong answer. It is not acceptable.

We have to turn things around and make the things that really matter for our patients, and the providers taking care of them, make these be the low hanging fruit, the easy stuff to say yes to.